title: The prognosis of patients on hemodialysis with foot lesions.
abstract: OBJECTIVE
  Many studies have shown the high prevalence and incidence of peripheral arterial disease and the marked morbidity and mortality associated with peripheral arterial disease in hemodialysis patients. The purpose of this retrospective study was to clarify the probability of survival and limb salvage in patients with foot lesions and how to manage these patients.
  
  
  METHODS
  Data were collected in a retrospectively maintained database for 319 lower limbs with foot lesions in 234 hemodialysis patients treated in a university hospital between 1980 and 2011. Variances influencing survival and limb salvage were compared using log-rank tests and Cox regression analysis. These variables were examined using Kaplan-Meier analysis. Significant factors in bivariate analysis were included in a logistic regression model to determine independent predictors and the probability of failure.
  
  
  RESULTS
  The 234 patients (72% men) were a mean age of 65.4 years on admission, and 84% had diabetes. The mean duration of hemodialysis was 6.8 years. During the follow-up period, 171 patients (73%) died. The 1-, 3-, 5-, and 7-year survival rates were 65.2%, 35.5%, 23.4%, and 12.8%, respectively. According to Cox multivariate models, age at admission and ischemic changes on an electrocardiogram independently increased the risk of death (hazard ratios, 1.02 and 1.48, respectively). Conversely, hyperlipidemia independently decreased the risk of death (hazard ratio, 0.56). Critical limb ischemia was present in 247 limbs (77%). Arterial reconstruction was done in 88 limbs (28%), and 119 limbs (37%) required major amputation. The overall 1-, 3-, 5- and 7-year limb salvage rates were 68.9%, 57.2%, 53.8%, and 51.7 %, respectively. According to Cox multivariate models, patent arterial reconstruction and albumin independently decreased the risk of major amputation (hazard ratios, 0.265 and 0.392, respectively).
  
  
  CONCLUSIONS
  Hemodialysis patients with foot lesions have a poor prognosis, with high rates of mortality and amputation. Prompt assessments of the severity of systemic conditions, such as cardiac ischemia, and focal wound conditions, such as ischemia and infection, are necessary to treat hemodialysis patients with foot lesions.
authors.affiliation: Division of Vascular Surgery, Department of Surgery, Aichi Medical University, Nagakute, Japan. Electronic address: oriyuki@aichi-med-u.ac.jp.
authors.forename: Yuki
authors.initials: Y
authors.lastname: Orimoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Ohta
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Ishibashi
authors.forename: Ikuo
authors.initials: I
authors.lastname: Sugimoto
authors.forename: Hirohide
authors.initials: H
authors.lastname: Iwata
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Yamada
authors.forename: Masao
authors.initials: M
authors.lastname: Tadakoshi
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Hida
mesh_terms: D000368:Aged; D000671:Amputation, Surgical; D017719:Diabetic Foot / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007564:Japan; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D023821:Limb Salvage; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D058729:Peripheral Arterial Disease / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality